TN 4 (02-12)
HI 01194.001 Annual Income-Related Monthly Adjustment Amount (IRMAA) Notices
Exhibits of the notices we send to Medicare Part B enrollees and prescription drug coverage beneficiaries affected by an Income-Related Monthly Adjustment Amount (IRMAA) are in sections HI 01194.005 through HI 01194.020. For an explanation of IRMAA see HI 01101.001
For title II beneficiaries with IRMAA, this notice replaces the annual Benefit Rate Increase BRI notice. The IRMAA BRI notice contains all of the standard information that appears in BRI notices, as well as information about IRMAA. Non-title II Medicare beneficiaries receive only information about IRMAA in the same mailing. All Annual IRMAA notices contain information about how the IRMAA was determined, how a beneficiary may request a new initial determination, appeal rights, and referral language.
All beneficiaries with a Spanish language indicator receive the annual IRMAA notice in Spanish. Spanish language versions of all Universal Text Identifiers UTIs are available in the Language Development facility under the associated UTIs, listed in HI 01190.020.